Catastrophic Stem Taper Wear in Ceramic on Polyethylene Bearing Couple: A Case Report

Kusaba, Atsushi; Katsui, Mariko; Hakuta, Naoyuki; Tsuchida, Masanori; Maeda, Akito; Kondo, Saiji

doi:10.1615/jlongtermeffmedimplants.2014011133

Cited by 4 publications

(1 citation statement)

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“…Only a few trunnion failures coupled with ceramic heads have been reported in the literature, while nearly all reported trunnionosis cases occurred with CoCr alloy heads . Retrieval studies and in vitro testing of ceramic heads suggest a reduction, but not the elimination, of trunnion fretting and corrosion .…”

Section: Discussionmentioning

confidence: 99%

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

Rowan

Wach

Wright

et al. 2018

Journal Orthopaedic Research

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Mechanically assisted crevice corrosion (MACC) is a mechanism for trunnion damage in total hip arthroplasties (THAs). Retrieval studies have shown reduced MACC-related damage for ceramic heads compared with cobalt-chromium (CoCr) heads. We propose that ceramic heads demonstrate fretting at higher cyclic compressive loads than CoCr heads on titanium alloy trunnions in a simulated corrosion model. A closed electrochemical chamber was used to measure fretting current onset loads for two modern titanium alloy trunnions (Zimmer 12/14 and Stryker V-40) in which trunnion failure has been reported. Ceramic and CoCr alloy 36 + 0 mm heads were impacted on each trunnion and cyclically loaded at 3 Hz with increasing magnitude from 100 to 3,400 N for 540 cycles. Onset load was the cyclic compressive load at which the slope of the average fretting current increased significantly. A CoCr head with V40 trunnion demonstrated the lowest onset load (1,400 N), while the V40 trunnion with a ceramic head showed the highest onset load (2,200 N). Significant differences occurred in average fretting current between head materials for V40 trunnions (p < 0.001) at loads over 2,000 N. CoCr-12/14 and ceramic-12/14 couples demonstrated similar onset loads (2,000 N). All head-trunnion combinations showed cyclical fretting response to loading at 100 N. Head material composition was observed to increase fretting at the taper junction but the effect was taper geometry dependent. Using ceramic heads may reduce the phenomena of trunnion fretting and corrosion but the effect of both trunnion geometry and metallurgy warrants further investigation. Statement of clinical significance: Trunnion corrosion may occur with titanium alloy stems regardless of the head material used. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1630-1636, 2018.

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Section: Discussionmentioning

confidence: 99%

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

Rowan

Wach

Wright

et al. 2018

Journal Orthopaedic Research

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The influence of surgical technique guidance and surgeon’s experience on the femoral head assembly in total hip arthroplasty

Darowski,

Ruehrmund,

Kluess

et al. 2024

Arch Orthop Trauma Surg

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Introduction The importance of the assembly procedure on the taper connection strength is evident. However, existent surgical technique guides frequently lack comprehensive and precise instructions in this regard. The aim of our experimental study was to evaluate the influence of the surgical technique guide on the femoral head assembly procedure in surgeons with differing levels of experience in total hip arthroplasty. Materials and methods Twenty-eight participants, divided into four groups based on their lifetime experience in total hip arthroplasty, conducted a femoral head assembly procedure in a simulated intraoperative environment before and after reviewing the surgical technique guide. Demographic information and the number of hammer blows were documented. Hammer velocity and impaction angle were recorded using an optical motion capturing system, while the impaction force was measured using a dynamic force sensor within the impactor. Results We observed a high variation in the number of hammer blows, maximum force, and impaction angle. Overall, the number of hammer blows decreased significantly from 3 to 2.2 after reviewing the surgical technique guide. The only significant intragroup difference in the number of hammer blows was observed in the group with no prior experience in total hip arthroplasty. No correlation was found between individual factors (age, weight, height) or experience and the measured parameters (velocity, maximum force and angle). Conclusions The present study demonstrated a high variation in the parameters of the femoral head assembly procedure. Consideration of the surgical technique guide was found to be a limited factor among participants with varying levels of experience in total hip arthroplasty. These findings underline the importance of sufficient preoperative training, to standardize the assembly procedure, including impaction force, angle, and use of instruments.

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Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

Urish

Hamlin

Plakseychuk

et al. 2017

The Journal of Arthroplasty

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Background Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty reported across a range of manufacturers. Specific lots of the Stryker LFIT Anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August of 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. Methods We report on 28 patients (30 implants) with either GTF (n=18) or head-neck taper corrosion (n=12) of the LFIT CoCr femoral head and the Accolade TMZF femoral stems. All of these cases were associated with adverse local tissue reaction (ALTR) requiring revision of the THA. Results In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0±1.4 years from the index procedure. Failures were associated with a high offset 127° femoral stem nec k angle and increased neck lengths. 43.3% (13/30) of the observed failures included implant sizes outside of the voluntary recall (27.8% (5/18) of the GTF and 75.0% (8/12) of the taper corrosion cases). Serum cobalt and chromium levels were elevated (Cobalt: 8.4±7.0μg/mL; Chromium: 3.4±3.3μ/L; Cobalt/Chromium ratio: 3.7). MARS MRI demonstrated large cystic fluid collections typical with ALTR. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared to the neck taper on radiographs. Conclusion In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful Accolade TMZF THA with unknown etiology. Almost half of the failures we observed included sizes outside of the voluntary recall.

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Catastrophic Stem Taper Wear in Ceramic on Polyethylene Bearing Couple: A Case Report

Cited by 4 publications

References 0 publications

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

The influence of surgical technique guidance and surgeon’s experience on the femoral head assembly in total hip arthroplasty

Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

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